Summary :
I know it is unwise to open introductory remarks with excuses because they instantaneously weaken the impact and preempt the thrust of the message. Nonetheless, I wish to offer an explanation for the enormous delay of this publication in spite of my good intention to comply with the warm encouragement for a timely revision. In 1989, immediately after the completion of the second edition, unforeseen turns of events prompted my unscheduled return to Kyoto to teach at my alma mater. I was able to maintain close ties with the University of Iowa thanks to Dr. Antonio Damasio, Chair of the Department of Neurology, who offered me a joint appointment with a ten-year leave of absence. Despite this liaison, an unplanned relocation at once doomed any hopes of repeating a six year cycle of revisions from the original date of publication in 1983. Besides, continued involvement with the Muscle & Nerve, as well as the International Federation of Clinical Neurophysiology (IFCN) and the World Federation of Neurology (WFN), in essence, precluded any progress toward a timely finish. Additionally, I found myself in the midst of a reentry crisis after a 30 year stay abroad which climaxed with a sadly misdirected legal probe into our accounting of research donation from pharmaceutical industry and the fund raising for the 10th International Congress of EMG and Clinical Neurophysiology (X-ICEMGCN Kyoto, 1995). Ironically, the incident provided me with an unexpected opportunity to concentrate on rewriting the manuscripts as prolonged and persistent press surveillance all but forced my unintended seclusion at home. In fact, I found myself in an ideal position to update the text using ample and uninterrupted time with which to analyze bits and pieces of documents assembled over the past several years. The turmoil, which was widely publicized in Japan as one of the biggest scandals of 1997, ended triumphantly (for us) with the resignation of the prosecutor in charge and the disbandment of the special task force, proving yet again that justice may be blindfolded but the truth always sets you free. During this interim, some new fields have emerged in our discipline requiring their inclusion as additional chapters and other existing areas have gained importance in patient care necessitating expanded coverages. These include magnetic stimulation, human reflexes, late responses, motor unit number estimate, quantitative electromyography, and threshold electrotonus to mention only a few. Advanced technology has brought considerable modifications in theory and practice in many other areas, although the basic premises remain the same in electrophysiologic approaches and in clinical problem solving. Parallel advances in other fields of neuroscience have led to equally exciting progress in the exploration of many disease processes in general, and to the understanding of neuropathies, muscular dystrophies, myasthenic syndrome and movement disorders in particular. I have thus rewritten, in their entirety, the chapters on principles and variation of conduction studies; facts, fallacies and fancies of nerve stimulation technique; other techniques to assess nerve function; the F wave and A wave; somatosensory and motor evoked potentials; electrodiagnosis in the pediatric population; and all the clinical sections included in Part VI and Part VII with the addition of ethical consideration in clinical practice as an appendix. The remaining chapters also underwent substantial changes to reflect current understanding. The addition of some 2500 new papers, which I personally reviewed, attest to the incredible advances in what was once considered to be a static, rather than dynamic, field of clinical electrophysiology. To achieve comprehensive coverage, I retained most of the old articles to document earlier contributions. However, for the sake of brevity, the text emphasizes basic principles, summarizing only pertinent points for day to day practice. The inclusion of ample new references should enable interested readers to consult the original papers for further details. My decision to take on this venture affected—directly or indirectly—many innocent bystanders who had to shoulder additional workloads while I devoted myself in writing. In particular, I owe special thanks to our staff in Kyoto guided by Dr. Ichiro Akiguchi who, along with Dr. Shinichi Nakamura, Dr. Nobuyuki Oka and Dr. Shun Shimohama, assumed many administrative chores. Dr. Ryuji Kaji, together with Dr. Nobuo Kohara, supervised the Clinical Neurophysiology Laboratory where our post-doctoral fellows contributed many new research insights useful for this revision. I am most grateful to Professor Hiroshi Shibasaki and his staff, which consisted of Dr. Hidenao Fukuyama, Dr. Takashi Nagamine and Dr. Akio Ikeda of the Department of Clinical Brain Pathophysiology for their support. Our secretarial personnel, including Mari Yamane, Kayoko Morii, Kyoko Maekawa, Tomoko Noboru and Kumiko Imai, processed an enormous amount of English literature without having prior exposure to foreign materials. Last, but not least, Machiko Miyamoto typed and retyped the entire volume single-handedly, as she was the only Japanese assistant proficient in English. It was my good fortune to be able to complete the revision at the Division of Clinical Neurophysiology at the University of Iowa headed by Dr. Thoru Yamada, who directs the EEG section there with the assistance of Drs. Malcom Yeh and Dr. Mark Granner. I enjoyed a most flexible time schedule in the EMG section thanks to Dr. Edward Aul who filled in whenever necessary, along with the help of Dr. Torage Shivapour and Dr. Jon Tippin. Dr. Eric Dyken, in charge of the Sleep Disorder Laboratory, read the entire book and provided useful suggestions. David Walker, M.S.E.E., rewrote the appendix on electronics, which was previously co-authored by Pete Seaba, M.S.E.E., who also gave helpful advice. I am indebted to Sheila Mennen, Shelli Hahn and Leigha Rios for their indispensable technical and clerical help during my renewed parttime work in Iowa. Ms. Mennen had already assisted with the first and second editions, therefore, I appreciated her sentiment when she inquired as to whether there would ever be a fourth edition! I would also like to thank Lauren Enck and Susan Hannan at Oxford University Press for inheriting the 3rd edition from F.A. Davis in the midst of production, and for guiding me with patience and encouragement despite the slow progress of the adopted project. I am indebted to the American Association of Electrodiagnostic Medicine (AAEM) and its Nomenclature Committee, who granted me permission to reprint the AAEE Glossary of Terms in Clinical Electromyography (1987) as Appendix 5. In concluding this acknowledgment, I wish to update a personal note on our household which, in the earlier editions, triggered many kind remarks. We now have an attorney in San Francisco, a resident physician in Madison, and a counselor for handicapped children in our home base in Iowa City. Junko, my wife, often refers to herself as “an international cleaning lady“, and periodically visits all five posts including my retreat in Kyoto, which is buried under manuscripts and always ranks bottom in her assessment. Our boys have finally grown old enough to appreciate the magnitude of the work involved in producing a textbook. For my 60th birthday, which in Japan customarily warrants a special celebration in recognition of one's accomplishment (regardless of any achieved), our three sons and a daughter-in-law came to Kyoto to honor my endeavors. I consider it my good fortune to be able to work on this edition in such a warm and conducive environment. This book is again dedicated to Junko in appreciation for her companionship, and to our growing family to acknowledge their compassionate, albeit spiritual, support. I take great comfort in the thought that, at long last, we may endow the royalty from this book as down payment for their first homes rather than tuition: I am thrilled that, for a change, we can actually witness the rewards of our investment!

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